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What is alarplasty? | Nostril features it treats | Who may be suitable | On its own or with rhinoplasty | The procedure | Techniques | Scars | Recovery | Risks | Cost | Consultation | Related guides
What is alarplasty?
Alarplasty is surgery that reduces the width, flare or asymmetry of the nostrils by removing or repositioning a small amount of tissue at the alar base or the nostril sill. It is also called alar base reduction or nostril reduction. It changes the lower outer nose only: the bridge, the tip and the airway are treated by other procedures.
The ala (plural alae) is the curved wing of skin and soft tissue that forms the outer wall of each nostril. Where the ala joins the face is the alar base, which sits in the alar-facial groove, the crease between the nostril and the cheek. The nostril sill is the floor of the nostril opening, where it meets the upper lip. Alarplasty works on these structures.
- Operating time: about 1 hour on its own
- Setting: simple alarplasty under local anaesthetic in the rooms; otherwise under general anaesthesia in an accredited private hospital, including whenever it is combined with rhinoplasty
- Sutures out: at about 1 week
- Back to desk-based work: usually 1 to 2 weeks
- Scars: fine scars in the alar-facial groove or at the nostril sill, which mature over 6 to 12 months
- Fee: $6,000 for simple alarplasty in the rooms, or about $9,300 in hospital on its own
- Medicare: not eligible when performed to change appearance
What it can and cannot change. Alarplasty can narrow a wide nostril base, reduce outward flaring of the nostril rims and make nostril asymmetry less visible. It cannot make the whole nose smaller, lower a dorsal hump, refine a bulbous tip or make breathing easier. Because tissue is removed, the change is not simply reversible, so the plan is conservative.
Nostril and alar base features alarplasty is used for
A nose can look wide for different reasons. The assessment looks at the nose from the front, from the side and from below (the basal view), to see whether the width comes from the nostrils, the tip or the bony bridge.
Wide nostril base
The nostrils sit wide on the basal view and in relation to the tip, the bridge and the face. Alarplasty narrows the base by removing a small amount of tissue at the outer edge of each nostril, at the nostril sill, or both, depending on the anatomy. Narrowing is kept conservative, because over-reduction is difficult to reverse and can leave the nostrils looking pinched.
Alar flare
The nostril rims curve outward beyond the rest of the nose, most visibly from the front and in three-quarter view. A small wedge of tissue is removed from the ala so that the rim sits closer to the centre of the nose, with the aim of a less flared outline from the front.
Nostril asymmetry
Some difference between the two nostrils is normal. Asymmetry may be present from birth, or follow an injury or previous nose surgery. Where it is noticeable, one or both sides can be adjusted to make the difference less visible. Complete symmetry is not a realistic aim.
Nostril width as part of a broader plan
A wide alar base often sits alongside other features, such as a low or wide bridge, a less projected tip or thicker skin. When several features are being changed, alar base work is usually planned as part of a rhinoplasty rather than as a separate operation (see on its own or with rhinoplasty below).
Nostrils that collapse when you breathe in are a different problem. That is usually a weakness of the nasal valve rather than width or flare, and alarplasty does not treat it. Our article on nasal valve collapse explains how it is assessed.
Who may be suitable for alarplasty?
Alarplasty (nostril reduction) may suit people whose main wish is narrower, less flared or more even nostrils, where examination shows that the alar base or nostril sill is responsible. Suitability usually includes:
- nasal growth that is complete (additional safeguards apply under 18, explained on the teen rhinoplasty page)
- good general health, with any medical conditions well controlled
- not smoking or using any nicotine product, including vapes, for a period before and after surgery, because nicotine impairs wound healing
- a scarring history that has been discussed: a tendency to keloid or hypertrophic scars does not always rule surgery out, but it changes the risk discussion and may change the technique
- realistic expectations about scars, symmetry and how much change is achievable
When alarplasty may not be the right operation
- The tip is the main source of width: tip rhinoplasty is usually discussed.
- The bridge, a dorsal hump or the overall size of the nose is the main issue: rhinoplasty is usually discussed.
- Breathing is blocked: septoplasty or functional rhinoplasty may be needed.
- The nose has been operated on before: the assessment is individual, so bring any operation records you have.
- The hope is for a smaller nose overall, or for complete symmetry: alarplasty cannot provide either.
Where any of these apply, Dr Turner explains the options at consultation, and the answer may be a different procedure or no surgery.
Alarplasty on its own or with rhinoplasty
Many people who feel their nose looks wide are describing the tip or the bridge rather than the nostrils. This table is a general guide. Which procedure applies is confirmed only at consultation.
| What you notice | Procedure usually discussed |
|---|---|
| Wide or flared nostrils, with a tip and bridge you are content with | Alarplasty on its own |
| A wide, rounded or bulbous tip, with nostrils of normal width | Tip rhinoplasty |
| Both a wide tip and wide nostrils | Tip rhinoplasty with alarplasty |
| A dorsal hump, a wide bridge or a change to the whole nose | Rhinoplasty in Sydney, with alarplasty if the nostrils are also wide |
| A blocked nose as well as wide nostrils | Breathing surgery planned together with alarplasty |
How alarplasty is planned with rhinoplasty
Changing the bridge or the tip changes how the nostrils look, even without any work on the alar base. Rotating the tip changes how much nostril shows from the front, and reducing the bridge changes the proportion between the nostrils and the rest of the nose. Nostrils that look wide before surgery may look in proportion once the tip and bridge have been changed, and the reverse can also happen.
For that reason, in a combined operation the alar base is assessed last, after the bridge and tip have been adjusted, so that any reduction is matched to the new shape of the nose. This lowers the risk of narrowing the nostrils more than needed. When alarplasty is added to a rhinoplasty, recovery follows the rhinoplasty.
The nose surgery in Sydney page compares all of the nose procedures.
How alarplasty is performed
Alarplasty on its own takes about 1 hour. Simple alarplasty can be performed under local anaesthetic in the rooms. Otherwise it is performed under general anaesthesia with a specialist anaesthetist as day surgery in an accredited Sydney private hospital. Which setting suits depends on the technique and the extent of the plan, and is agreed at consultation. When alarplasty is combined with rhinoplasty, it is always performed in hospital under the same general anaesthetic, and the operating time and hospital stay follow the rhinoplasty.
- Marking. The nose is marked with you sitting upright, so that the alar base is assessed in its usual resting position rather than lying flat.
- Anaesthesia. Local anaesthetic in the rooms for simple alarplasty, or general anaesthesia given by a specialist anaesthetist in hospital.
- Incisions. Placed according to the technique: in the alar-facial groove for a wedge excision, at the nostril sill for a sill excision, or both.
- Reduction. A small, measured amount of tissue is removed or repositioned, with the two sides compared throughout.
- Closure. Deep sutures support the tissue and fine sutures close the skin, with tension kept low to help the scars settle.
- Dressings. Small dressings are applied as needed, and you go home the same day.
Nostril reduction techniques
The technique is matched to the feature being treated, the skin and whether other nose surgery is planned. Many patients need a combination.
| Technique | What it treats | Where the incision sits |
|---|---|---|
| Alar wedge excision | Alar flare and the outward curve of the nostril rim | In the alar-facial groove, where the nostril meets the cheek |
| Nostril sill excision | Width at the floor of the nostril, where it meets the upper lip | At the nostril sill |
| Combined wedge and sill excision | Both flare and a wide nostril floor | In the alar-facial groove and at the nostril sill |
| V-Y advancement | Rarely used; selected cases where the position of the alar base, rather than excess tissue, causes the width | A small scar in the subalar region, on the upper lip just below the nostril |
Three principles apply to every technique. Tissue removal is conservative, because a small change in tissue gives a visible change in nostril shape and over-reduction is hard to reverse. Both sides are measured and compared so that the changes match. Incisions are placed in existing creases, where a scar is less likely to be noticed, although visibility still varies between people.
Alar wedge excision
A wedge of tissue is removed from the ala, with the incision placed in the alar-facial groove rather than inside the nostril opening. It is used mainly for alar flare, and it can also reduce the width of the nasal base as seen from the front. The amount removed is planned to keep the existing curve of the ala.
Nostril sill excision
Tissue is removed from the floor of the nostril, where it meets the upper lip. It is used where the nostril base is wide because the sill is wide. Where the width comes mainly from the sill and there is little flare, a sill excision alone may be enough; where flare is also present, it is combined with a wedge excision.
V-Y advancement
A V-Y advancement repositions the base of the ala when the point where it joins the face, rather than excess tissue, is responsible for the width. It is used rarely, in selected cases, and leaves a small scar in the subalar region, on the upper lip just below the nostril.
Where are alarplasty scars, and will they show?
Alarplasty leaves a scar wherever tissue is removed or repositioned. With a wedge excision the scar sits in the alar-facial groove; with a sill excision it sits at the nostril sill, at the junction with the upper lip. A V-Y advancement, which is used rarely, leaves a small scar in the subalar region, on the upper lip just below the nostril. The wedge and sill scars are placed in existing creases, which helps them blend as they mature, but no scar disappears completely.
Early scars are usually pink or red and fade towards skin colour over 6 to 12 months. How visible a scar becomes depends on:
- skin type, as some skin is more prone to scarring and to changes in pigment
- healing tendency, including any history of keloid or hypertrophic scars elsewhere
- sun exposure while the scar is healing, which can permanently affect its colour
- tension on the closure and the suture technique
- aftercare during the first 6 to 12 months
Even with the same technique and aftercare, scars vary between patients. A raised, widened or darker scar can develop and may need scar treatment or, occasionally, revision. If you have a history of keloid or hypertrophic scarring, raise it at consultation.
Alarplasty recovery
Recovery from alarplasty on its own is usually shorter than recovery from rhinoplasty, because the work is limited to the nostrils. Healing varies between people.
| Time | What to expect |
|---|---|
| First week | Mild swelling and discomfort at the base of the nose. Wound care instructions are followed, and sutures are removed at about 7 days. |
| Weeks 1 to 2 | Most patients return to desk-based work. The early scars look pink or red. |
| Weeks 4 to 6 | Light exercise usually resumes from week 4. Strenuous activity and contact sport wait until you are cleared. |
| Months 3 to 6 | The scars gradually soften and fade, but often remain pink. |
| Months 6 to 12 | The scars continue to mature towards skin colour. |
When the change becomes apparent
Swelling and early scarring affect how the nostrils look in the first weeks, so the final appearance is judged as the scars mature over 6 to 12 months. Results vary between patients and cannot be predicted with certainty.
Reviews are at suture removal (about 1 week), then at 6 weeks, 3 months and 6 months. When alarplasty is combined with rhinoplasty, the longer rhinoplasty recovery applies; our rhinoplasty recovery week by week guide explains it.
Alarplasty risks and complications
Alarplasty is surgery and carries risk. Risks specific to nostril reduction include:
- visible scarring, including raised or widened scars, particularly in the first 6 to 12 months
- asymmetry between the nostrils, even with careful measurement
- over-reduction, which can make the nostrils look pinched and is difficult to reverse
- nostril distortion or notching of the rim at the incision
- delayed healing or wound separation, more likely where tension on the closure is high
- changes in sensation, usually temporary numbness around the base of the nose
General risks include bleeding, infection, dissatisfaction with the appearance of the nostrils, the need for further surgery, and the risks of anaesthesia.
The most important point to understand before surgery is that alarplasty is not simply reversible. Once tissue has been removed it is difficult to restore, and the options for revision are limited. This is why the plan is conservative and expectations are discussed in detail before surgery is booked. The risks that apply to you depend on your anatomy, skin, scarring history, general health and nicotine use, and are explained at consultation. More information is on the risks and complications page.
Cost of alarplasty in Sydney
| Alarplasty (nostril reduction) | Fee (all-inclusive, 2026) |
|---|---|
| Simple alarplasty on its own, under local anaesthetic in the rooms | $6,000 |
| On its own, as day surgery in hospital | About $9,300 |
| Combined with a rhinoplasty, in hospital | About $4,650 added to the rhinoplasty fee |
The fee depends on the technique, the setting and whether other surgery is combined, and it is confirmed in a written quote after consultation. The consultation fee is $450.
Alarplasty performed to change the appearance of the nostrils is not eligible for Medicare benefits or private health insurance cover. Where breathing surgery is performed at the same time and its criteria are met, benefits apply only to that part (see Medicare and nose surgery). Our guide to alarplasty and rhinoplasty fees explains what affects the cost.
Consultation and choosing a surgeon
Alarplasty is a small operation on a visible part of the face, and much of the planning lies in judging how much tissue to remove. It is reasonable to check that your surgeon is a Specialist Plastic Surgeon on the public AHPRA register, assesses the whole nose rather than the nostrils alone, and explains where the scars will sit for your skin. The guide to choosing your plastic surgeon covers what to ask.
Dr Scott J Turner is a Specialist Plastic Surgeon who was awarded FRACS in 2013 and holds AHPRA registration MED0001654827. He is a member of the Australian and New Zealand Board of Cosmetic Plastic Surgery. At consultation he examines the nostrils, alar base, tip and bridge from the front, the side and below, asks about your scarring history and any previous nose surgery or injury, and explains which technique and setting may suit you, along with the alternatives, including not having surgery.
A referral from your GP or another registered medical practitioner is needed before the first consultation. At least two consultations with Dr Turner are held before surgery can be booked: at least one is in person, and the other may be by video. After both consultations and signed consent, a cooling-off period of at least seven days applies before surgery can be booked or a deposit paid. Additional safeguards apply to patients under 18. To arrange a consultation, contact us.
Frequently Asked Questions
What is alarplasty?
Alarplasty is surgery that reduces the width, flare or asymmetry of the nostrils by removing or repositioning a small amount of tissue at the alar base, where the nostril meets the cheek, or at the nostril sill, where it meets the upper lip. It may be performed on its own or as part of a rhinoplasty. It does not change the bridge, the tip or breathing.
Is alarplasty the same as nostril reduction or alar base reduction?
Yes. Alarplasty is the surgical name, and nostril reduction, nostril surgery, nostril reshaping, alar base reduction and alar reduction are common names for the same operation or its variants. Whichever name is used, the work is on the alar base or the nostril sill, to change nostril width, flare or asymmetry.
Is alarplasty better than rhinoplasty?
Neither is better; they treat different parts of the nose. Alarplasty narrows the nostril base and reduces flare. Rhinoplasty changes the bridge, the tip or the overall shape and size of the nose, and tip rhinoplasty changes the tip cartilages. If the tip or bridge makes the nose look wide, alarplasty alone will not change it. Many patients have alarplasty with a rhinoplasty when both are involved.
Where are alarplasty scars, and will they show?
With a wedge excision the scar sits in the crease where the nostril meets the cheek; with a sill excision it sits at the base of the nostril, where it meets the upper lip. A V-Y advancement, which is used rarely, leaves a small scar on the upper lip just below the nostril. The scars usually fade towards skin colour over 6 to 12 months, but they do not disappear. Raised or widened scars are possible, and visibility varies between patients.
Can alarplasty be done with rhinoplasty?
Yes. Alarplasty is often added to a rhinoplasty or a tip rhinoplasty when the nostrils are also wide, and the combined operation is performed in hospital. The alar base is assessed last in the operation, after the bridge and tip have been changed, so that any reduction matches the new shape of the nose. When combined, alarplasty adds about $4,650 to the rhinoplasty fee, and recovery follows the rhinoplasty.
How long is recovery after alarplasty?
After alarplasty on its own, sutures are removed at about 7 days and most patients return to desk-based work within 1 to 2 weeks. Light exercise usually resumes from week 4, and strenuous activity and contact sport wait until you are cleared. The scars mature over 6 to 12 months. Recovery is longer when alarplasty is combined with rhinoplasty.
How much does alarplasty cost in Sydney?
Simple alarplasty on its own is $6,000 under local anaesthetic in the rooms, and alarplasty on its own as day surgery in hospital is about $9,300. Combined with a rhinoplasty, it is performed in hospital and adds about $4,650 to the rhinoplasty fee. The fee is confirmed in a written quote after consultation, and the consultation fee is $450. Alarplasty performed to change appearance is not eligible for Medicare benefits or private health insurance cover.
Can alarplasty be reversed?
Not easily. Once tissue has been removed it is difficult to restore, and if the nostrils have been over-reduced the options for revision are limited and may not return them to their original shape. This is why the amount removed is planned conservatively and expectations are discussed in detail before surgery is booked.
Related guides
- Tip rhinoplasty: when the width is in the tip rather than the nostrils
- Rhinoplasty: changes to the bridge and the shape of the whole nose
- Bulbous nose tip: causes, and when tip surgery may help
- Mini nose job or tip rhinoplasty: whether tip-only surgery is enough
- How to choose a rhinoplasty surgeon: registration, training and what to ask
- Rhinoplasty recovery week by week: for alarplasty combined with rhinoplasty
